California Equine Orthopedics, Inc

Cervical (Neck) Injections

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In our practice, we believe that any horse with neck stiffness, mild ataxia,
intermittent or unrelenting forelimb lameness or obscure hindlimb lameness
should be investigated for cervical issues. Most horses that exhibit abnormal cervical
manipulation either resist lateral flexion totally or avoid lateral flexion by
offering a more ventral flexion of the head and neck (as in the video above). The rider often describes resistance to
lateral bending, being ‘heavy on one rein’ or resistance to achieving the frame
desired.

It can be difficult to rule out problems in
the cervical region without the screening tool of nuclear
scintigraphy (above), as these areas are
easily highlighted by increased radiopharmaceutical uptake (arrow above). Radiography alone can be used to document some
cases of cervical arthropathy.
Radiography can highlight enlarged facets (arrow below),
previous trauma (such as fracture) or entheseous bone formation and narrowing
of the spinal canal, although these findings may not always carry clinical
significance.

Once it is determined that a cervical facet arthrosis is present, treatment may include ultrasound-guided facet injections. The technique is demonstrated in the following photos. After
alcohol is sprayed over the cervical region, the facet joints to be injected
are located via ultrasound examination (above).

The facet joint is located ultrasonographically and local anesthetic is injected
just dorsal to the probe with a 25 gauge needle (above). The
local anesthetic is placed as a bleb under the skin and then somewhat deeper
into the muscle, especially on more sensitive horses. In this case, the bleb for C5-6 is being
placed, while the bleb for C6-7 can be seen in the background (below).

Once
the area is scrubbed again and sprayed with alcohol, the facet joint is located
with the ultrasound and an 18 gauge spinal needle is introduced at a 45 degree
angle just dorsal to the probe (above). The assistant removes the stylet and injects the
medication while the ultrasonographer steadies the needle and continues to view
the screen ensuring that the medication is deposited into the joint space (below).

The video below shows the needle advancing from the upper left quadrant of the ultrasound screen toward the cervical facet joint to be treated. The cloud appearing at the end of the needle is the medication actively being injected into the joint.